Many charity leaders winced last year when they heard the then-health secretary Wes Streeting talking about wanting to “break the culture of the voluntary sector” when it comes to lobbying government.
Few will have been listening more intently than I was, because it was the charity I led that prompted those remarks. They came after the Royal Osteoporosis Society (ROS) persistently pressed ministers to honour their commitment to roll out early-diagnosis clinics across England – a cause Streeting himself championed in opposition but which stalled during his time in government. In the same leaked recording, he described ROS as “stakeholders, not partners”.
Those remarks were prompted by one campaign. But they raise a much bigger question than any one minister, government or charity: what should governments expect from civil society?
I understand the frustration that sustained lobbying can create for ministers. But after six years leading a national health charity, I’ve come to the conclusion that government has far more to gain than to fear from a confident, campaigning voluntary sector.
Fundamental to achieving objects
The word “lobbying” can sometimes carry unhelpful baggage. For charities, it is simply one form of advocacy: bringing the lived experience of beneficiaries into public policy.
That’s a fundamental part of achieving the charitable objects of most voluntary sector organisations. A reality for most charities, particularly those in the health sector, is that they can’t service-deliver their way out of the social problem they exist to fix.
Take osteoporosis as an example: more than two million of the 3.5 million people living with this “silent condition” are currently undiagnosed and therefore missing out on vital treatments needed to prevent life-changing fractures. When I led the ROS, we could have multiplied the number of nurses on our helpline by a factor of 100 and it still would not have solved that problem.
The only way to change lives at scale was to help reform the NHS itself: raising awareness, building evidence, persuading ministers and encouraging the system to change. And that meant campaigning.
Campaigning was therefore not an optional extra or a distraction from our charitable purpose. It was an essential part of fulfilling it.
Feedback, not opposition
The most obvious benefit to ministers is that constructive challenge improves policy. Governments routinely benefit from charities pointing out implementation problems, unintended consequences and inequities. Challenge from a free, independent and vocal voluntary sector should be seen as feedback rather than opposition.
Looking back over history, most major social reforms began with somebody being told they were being difficult. Whether the issue was hospice care, HIV, smoking or learning disabilities, charities have often been accused of being impatient, unrealistic or confrontational before their arguments became accepted policy.
Moreover, campaigning is not a failure of collaboration. Charities often raise concerns privately with ministers and officials over many years, but, for myriad reasons, things don’t change.
In those circumstances, charities don’t campaign publicly because they enjoy conflict or awkwardness. They do it because they recognise that their overriding duty is to the people they exist to serve. To remain silent would be both defeatist and an abdication.
I’ve occasionally heard senior NHS figures describe campaigning charities as “uncollaborative”. That sentiment misunderstands the relationship, as well the roles and responsibilities of different parts of the system. Patient-facing charities exist to champion the interests of people who use NHS services.
If charities become perceived as an extension of government, they lose the trust of the people they represent. And if the evidence points to there being a gap between policy commitments and delivery – as there was with osteoporosis services in the NHS – then charities owe it to their beneficiaries to shine a light on it.
Freedom to disagree
I certainly don’t believe partnership should mean silence. Indeed, the best partnerships depend on both sides retaining the freedom to disagree.
Think about what charities represent in civil society today. They’re groups – often vibrant movements – of people united across class, geography and background by lived experience of society’s most stubborn problems.
They bring perspectives that government simply cannot generate from within Whitehall. That perspective is precisely what ministers risk losing if charities become too cautious about speaking uncomfortable truths to power.
Of course, charities have responsibilities too. Campaigning should always be proportionate, truthful and evidence-based. We must focus on issues and not personalities.
Credibility is a charity’s greatest asset, and once lost it’s very difficult to regain. Equally, we mustn’t mistake publicity for impact - campaigning is a necessary tool to improve policy rather than an end in itself.
But governments should expect charities to challenge them. Indeed, I’d go as far as to say they should welcome it enthusiastically.
Independent charities are not difficult stakeholders to be managed. They’re informed partners in the difficult business of improving society. Sometimes the most valuable partner in the room is the one prepared to tell you that your current policy isn’t working.
